Methods: We used qualitative methods to explore reasons for poor rates of both ART initiation and ART adherence among HIV patients in rural KwaZulu-Natal, South Africa. We conducted focus groups with 21 CHWs during May-August 2014. Interviews were audio-recorded, transcribed, and translated from Zulu into English. Using Atlas.ti, hybrid deductive and inductive analytical methods borrowed from grounded theory were applied to identify emergent themes.
Results: We found that a core combination of psychosocial, socioeconomic, and socio-medical barriers— some previously unidentified in rural South Africa— act at the level of the individual, relationship/community, and healthcare environment to hinder both linkage to and retention in ART. Key themes included insufficient patient education/counseling and social support, patient dissatisfaction with healthcare services, socioeconomic factors, and tension between ART providers and alternative medicine healers. Fear of taking lifelong therapy was a barrier exclusive to non-initiation whereas substance abuse primarily contributed to default.
Conclusion: Successful management of HIV/AIDS requires education, counseling, and support extending beyond the initial diagnosis phase. Changing focus from HIV/AIDS as an acute infectious disease to a chronic disease model requiring a lifelong management plan appears to be key to improving ART initiation and long-term adherence. As CHWs likely appreciate these needs, the expansion of their roles to offer education for patients, partners, and family members, provide longitudinal support, and foster cooperation with alternative medicine providers could strengthen healthcare services in ways that successfully support ART initiation and adherence.
K. B. Loeliger,
N. Mntungwa, None
A. Moll, None
G. Friedland, None
S. Shenoi, None